Provider Demographics
NPI:1215930250
Name:PAGE, KIMBERLY ANN (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:PAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1388 COURT ST STE H
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1388 COURT ST
Practice Address - Street 2:SUITE H
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1660
Practice Address - Country:US
Practice Address - Phone:530-246-2207
Practice Address - Fax:530-243-6835
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-02-04
Deactivation Date:2006-03-29
Deactivation Code:
Reactivation Date:2006-04-27
Provider Licenses
StateLicense IDTaxonomies
CAG64229207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G642290Medicaid
CA00G642290Medicaid
CA00G642290Medicaid